Epidemic Intelligence Service (EIS)   Polio  Cutter

Epidemic Intelligence Service Claims Credit for Addressing Polio Vaccine Scare in the 1950s.
"People began to question that if this product was unsafe, how do we know that every other vaccine is safe?"

"The quick work of the EIS under Dr. Langmuir's direction helped allay fears, rescue the vaccine program, and restore public confidence in the vaccine and the U.S. Public Health Service."

                          The EIS was established in 1951 following the start of the Korean War as an early warning system against biological warfare and man-made epidemics. The program, comprised of medical doctors, researchers, and scientists who serve in 2-year assignments, today has expanded into a surveillance and response unit for all types of epidemics, including chronic disease and injuries.

                          Over the past 50 years, EIS officers have played pivotal roles in combating the root causes of major epidemics. The EIS played a key role in the global eradication of smallpox by sending officers to the farthest reaches of the world; restored public confidence in the first polio vaccine after a defective vaccine led to panic; and discovered how the AIDS virus was transmitted. More recently, EIS officers have documented the obesity epidemic in the United States, helped states reduce tobacco use, and studied whether disease outbreaks were a result of bioterrorism. Many of the nation's medical and public health leaders, including CDC directors and deans of the country's top schools of public health, are EIS alumniae.

                          During the frightening national polio epidemic, EIS officers lead efforts to trace 260 polio cases to unsafe vaccines made in California's Cutter Laboratories by setting up a national surveillance system. In a matter of weeks, extensive surveillance and epidemiologic investigation restores public confidence and confirms the vaccine's safety when produced under rigid controls. By 1956, half as many polio cases are reported as the year before.

                                EIS Officer: Neal Nathanson
                                Age: 73

                                Hometown: Boston

                                EIS Assignment: Served as chief of newly formed Polio Surveillance Unit from 1955-1957 and was involved in investigating the cause of a polio outbreak in 1955. Isolated the cause to two lots of vaccine from a particular manufacturer, helping to restore public confidence in the vaccine during a critical period in its early history.

                                Years in EIS: 1955-1957

                                Education: Harvard College (B.A., 1949); Harvard Medical School (M.D., 1953).

                                Where He Is Today: A resident of Philadelphia, Nathanson currently serves as vice provost for research at the University of Pennsylvania Medical School. He recently completed two and a half years as director of the Office of AIDS Research at NIH, where he is credited with bringing a public health perspective to the organization.

                          Disease Detectives Called in to Solve Polio Scare

                          Almost five decades have passed since the nationwide testing of the Salk polio vaccine. The largest medical experiment in history, its legacy is seen in current efforts to eradicate the world of this infectious viral disease that causes permanent paralysis. It was just five decades ago that parents in the U.S. were afraid to allow their children to go to a swimming pool or sandbox for fear the virus would confine them to a wheelchair.

                          Neal Nathanson, a medical resident from the University of Chicago and newly named EIS officer in 1955, vividly recalls the time. "The trial went from the spring of 1954 to the fall of that year. It wasn't until April 1955 that all the data were analyzed, which concluded that the Salk vaccine was 60 to 90 percent effective."

                          Five selected manufacturers, including the Cutter Laboratory in California, had already prepared the vaccine for widespread use in anticipation of a successful field trial. The FDA approved the vaccine, and children across the nation soon eagerly lined up to receive the vaccine in the spring of 1955. By the end of April, public euphoria over the vaccine's effectiveness came to a crashing halt when several cases of child paralysis occurred, causing a public panic and raising doubts over the vaccine's safety. On May 8, the U.S. Surgeon General suspended the entire U.S. vaccine program pending inspection of each manufacturer's production plant.

                          "People began to question that if this product was unsafe, how do we know that every other vaccine is safe? The credibility of the Public Health Service was also on the line," recalls Nathanson. It was essential to solve the polio cases before parents lost faith in the vaccines that protected their children from DTP (diphtheria, tetanus, pertussis) and other devastating diseases.

                          Overnight, CDC's chief epidemiologist, Alexander D. Langmuir, M.D., M.P.H., set up the Polio Surveillance Unit to investigate the outbreak. He staffed the unit with a secretary and two EIS officers including Nathanson, one of the few EIS officers never to have taken a formal EIS training course. Instead, he received on-the-job mentoring in the science of epidemiology from Dr. Langmuir himself.

                          The surveillance unit began gathering data from state health departments around the country, which received reports from local health departments on every case of polio reported. There was very little 'natural' polio occurring during that time of the year.

                          The public was anxious for information so CDC issued daily reports of its investigation. The New York Times printed the reports on its front page for a month, underscoring the national attention which the outbreak received.

                          "It became clear that these cases were associated with a couple of states - California and Idaho. Further investigation revealed that the source was from two lots of vaccine from a single manufacturer - the Cutter lab," Nathanson recalls. With the cause of the outbreak isolated by the EIS, the FDA quickly lifted its moratorium on the vaccine with the other manufacturers beginning on May 13.

                          The CDC reviewed 260 polio cases, including 94 recipients of the Cutter vaccine, 126 family members who were infected from close contact with the children, and another 40 community contacts.

                          The quick work of the EIS under Dr. Langmuir's direction helped allay fears, rescue the vaccine program, and restore public confidence in the vaccine and the U.S. Public Health Service. At the same time, the outbreak pointed to the need for a national disease surveillance capability. Today, CDC works with its partners to conduct surveillance for hundreds of diseases and conditions, such as AIDS, Lyme disease, lead poisoning, tobacco use, work-related injuries, birth defects and cancer.

                          The EIS' findings also led the federal government to establish more stringent standards for manufacturing vaccines and for testing the safety of products in general. Specifically, before a vaccine is licensed, manufacturers must provide a full production history and a consistent positive outcome on product safety testing.

                          The U.S. has not seen a new case of polio since 1979. Thanks to a global eradication effort spearheaded by CDC, the World Health Organization, Rotary International, and UNICEF, polio is limited to just 20 countries and is due to be eradicated by 2002.

                          "I feel very lucky - it was happenstance that I was drawn into this," says Nathanson of his EIS work with the Polio Surveillance Unit. Nathanson went on to serve as head of infectious diseases at Johns Hopkins Medical School, and in 1995 he retired from the University of Pennsylvania Medical Center after 17 years. Nathanson also just finished two and a half years as director of the Office of AIDS Research at NIH, where he is credited with "bringing a public health perspective to the organization."

                          While the Salk vaccine is well-regarded as the first step toward the elimination of polio, the pioneering investigative work of the EIS and the Polio Surveillance Unit ensured the vaccine's survival at a critical point in its young history. At the same time, the work of Dr. Langmuir, Nathanson and others fueled the creation of a nationwide disease surveillance capability by the CDC that continues to flourish today. (30)

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